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HomeMy WebLinkAbout868481Land Description Percent of Interest Percent of Overriding Royalty Or Similar interests Additional space on reverse, if needed. Do not submit documents or agreements other than this form; such documents or agreements shall only be referenced herein. A Owned b Conveyed c Retained d Reserved e Previously reserved or conveyed f Township 22 North, Range 115 West. 6' P.M. /9 BOOK '3 3 4 U 4) P R PAGE___._,_.____._._, 6 t 100% I 100% a 1 tir 00 9l 0% 1 0% V� t' d f' t 0% Section 5: Lots 1 -3, S2NE, SENW, S2 Section 6: Lots 2, 3, SWNE, SENW Section 7: E2W2, W2SE, SESE Section 8: E2, E2W2, SWNW, SWSW Section 17: N2, SW, W2SE Lincoln County, Wyoming Containing 2123.01 acres, more or less Form 3000 -3 (October 1992) I.f i Litt. t IN 1ER,O ;'h' 1.1- r UI fJ AGEMl.IC k 20 AUG -9 Alf 9: 50 V WYomiNG 1. Assignee* Street City, State, ZIP Code ASSIGNMENT OF RECORD TITLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.C. 351 -359) Geothermal Steam Act of 1970 (30 U.S.C. 1001 -1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) Baseline Minerals, Inc. 1645 Court Place, Suite 422 Denver, CO 80202 Type or print plainly In Ink and sign In ink. UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT PART A: ASSIGNMENT *If more than one transferee, check here and list the name(s) and address(es) of all additional transferees on the reverse of this form or on a separate attached sheet of paper. This transfer is for: (Check one) [X Oil and Gas Lease, or Geothermal Lease Interest conveyed: (Check one or both, as appropriate) X] Record Title. Overriding Royalty, payment out of production or other similar interests or payments 2. This assignment conveys the following interest: FOR BLM USE ONLY -DO NOT WRITE BELOW THIS LINE THE UNITED STATES OF AMERICA FOR ASSIGNEE This ssignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or equitable title to this lease. Assignment approved for abovete)l Assignment si g nment a pp roved effective JJ CC 11 LL By IS/ Carmen E. Lovett (Authorized Officer) Assignment approved for attached land description Assignment approved for land description indicated on reverse of this form AND LAW EXAMINER StP 0 1 2010 (Title) (Date) FORM APPROVED OMB NO. 1004 -0034 Expires: July 31, 1995 Lease Serial No WYW- 150892 Lease Effective Date August 1, 2000 ACKNOWLEDGMENT STATE OF COLORADO ,y COUNTY OF 1)0\ The foregoing instrument was acknowledged before me this My Commission Expires: 7g' (City) (Signature) 3064 South Dahlia Street (Assignor's Address) Denver, CO 80222 (State) (Zip Code) 3.4 day of otary Public PART B: CERTIFICATION AND REQUEST FOR APPROVAL Executed this day of <17- I. 2000 Executed this Name of Assignor as shown on cu lease Robert J. Kenney Assignee: Assignor: ','.".qi .r�11,4 a,l?t�, Assignee: Or tr ob ney (Si ature) or Attorney -in -fact Attorney -in -fact Assignee: Attorney -in -fact Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, if needed, or for Land Description in item No. 2 if needed 2000, by Robert J. Kenney,„? 141,4206 4 0 4 I certify, that the statements made herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith. (Signature) 1. The Assignor certifies as owner of an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above. 2. Assignee certifies as follows: (a) Assignee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under the laws of the United States or of any State or territory thereof. For the assignment of NPR -A leases, assignee is a citizen, national, or resident alien of the United States or associations of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Assignee is not considered a minor under the laws of the State in which the lands covered by this assignment are located; (c) Assignee's chargeable interests, direct and indirect, in each public domain and acquired lands separately in the same State, do not exceed 246,080 acres in oil and gas leases (of which up to 200,000 acres may be in oil and gas options), or 300,000 acres in leases in each leasing District in Alaska of which up to 200,000 acres may be in options, if this is an oil and gas lease issued in accordance with the Mineral Leasing Act of 1920, or 51,200 ,acres in any one State if this is a geothermal lease; (d) All parties holding an interest in the assignment are otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation requirements for all Federal oil and gas lease holdings as required by sec. 17(g) of the Mineral leasing Act: and (f) Assignee is not in violation of sec. 41 of the Mineral Leasing Act. 3. Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein. For geothermal assignments, an overriding royalty may not be less than one -fourth (1/4) of one percent of the value of output, nor greater than 50 percent of the rate of royalty due to the United States when this assignment is added to all previously created overriding royalties (43 CFR 3241). Of Q. BASELINE E LS, INC. gnature) Joseph W. Thame 'r ident Public reporting burden for this form is estimated to average 30 minutes per response including the lime for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U .S. Department of the Interior, Bureau of Land Management, (Altemate) Bureau Clearance Officer (WO -771), 1849 C Street, N.W., Washington, D.C. 20240, and the Office of Management and Budget, Paperwork Reduction Project (1004- 0034), Washington, D.C. 20503 Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.